<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392701177
Report Date: 11/07/2025
Date Signed: 11/07/2025 03:20:35 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/27/2025 and conducted by Evaluator Michael Bilger
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20250827115412
FACILITY NAME:TELECARE WHITE LANEFACILITY NUMBER:
392701177
ADMINISTRATOR:DANICA MORRISONFACILITY TYPE:
737
ADDRESS:1775 WHITE LANETELEPHONE:
(510) 621-9064
CITY:STOCKTONSTATE: CAZIP CODE:
95215
CAPACITY:4CENSUS: 2DATE:
11/07/2025
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Danica MorrisonTIME COMPLETED:
03:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff do not observe client for changes in his health condition
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 11-7-2025 at 1:15pm, Licensing Program Analysts (LPAs) Michael Bilger and Sommer Hayes arrived unannounced to continue investigation and deliver findings for the allegation noted above. LPA met with Administrator Danica Morrison and explained the purpose of the visit. During this investigation, LPA conducted interviews with seven staff members and reviewed facility documentation including individual program plan (IPP) for resident1 (R1), individual behavior support plan (IBSP) for R1, various photographs, hospital paperwork, email communications, physician orders, body check observation forms from August-October 2025 pertaining to R1.

Allegation: Staff do not observe client for changes in his health condition. LPA conducted interviews and record reviews as noted above. Based on interviews conducted, it was revealed that facility staff are instructed to perform routine body checks on residents as well as 15-minute wellness checks.

{Cont. on 9099C}
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 27-AS-20250827115412
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: TELECARE WHITE LANE
FACILITY NUMBER: 392701177
VISIT DATE: 11/07/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
A review of documentation including body/skin check and other observation forms indicate that facility staff have performed routine observation checks for R1 during the months of August, September and October 2025. A review of photographs indicated R1 sustained rashes on his armpit area between October 5-28 2025. Photograph revealed redness on the armpit area on the date of 10-5-2025. An additional photograph revealed this same rash as a brighter visual of redness on 10-28-2025. A further review of body check forms as noted above revealed that these rashes were not included as an observation. Interviews conducted revealed redness was observed in the armpit area prior to worsening conditions, but not revealed on body check forms. Additionally, a review of R1’s physician orders did not reveal a specific treatment medication or treatment plan for these specific rashes. Licensee was unable to provide additional evidence to conclude the specific rashes were treated timely for purposes of treatment.

As a result, the preponderance of evidence standard is met, and this allegation is SUBSTANTIATED. Citation is issued under Title 22, Division 6, and noted on LIC 9099D. A civil penalty in the amount of $250 is issued in addition to citation due to repeat violation of Section 80078(a) within a 12-month period. An exit interview was conducted with Administrator and a copy of this report was provided. LIC 811 and Appeal rights provided.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 27-AS-20250827115412
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: TELECARE WHITE LANE
FACILITY NUMBER: 392701177
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/07/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/10/2025
Section Cited
CCR
80078(a)
1
2
3
4
5
6
7
80078 Responsiblity for Providing Care and Supervision. (a) The licensee shall provide care and supervision as necessary to meet the client's needs. This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Licensee will ensure completed staff training on proper observation, follow up, and communication regarding resident changes in condition. Training date to be submitted to LPA by POC due date. Proof of completed training to be submitted to LPA no later than 11-24-25.
8
9
10
11
12
13
14
Based on interviews and record reviews, R1 sustained rashes on armpit area, and Licensee did not ensure proper observation and follow up. This posed an immediate health and safety risk to resident in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3